LESSON 12: HEALTH CARE WASTE MANAGEMENT

HEALTH CARE WASTE

- It refers to all solid or liquid wastes generated by any of the following activities.
1. Diagnosis, Treatment and Immunization of humans
3. Research using laboratory animals
4. Production and testing of biological products
5. Other activities performed by healthcare facility
- 75 – 90% of wastes are NON-HAZARDOUS
- 10-25% are HAZARDOUS (infectious, toxic or radioactive)
- High-income countries versus Low-income countries

HEALTH CARE WASTE GENERATORS

1. Hospitals and medical centers 5. Laboratories and research centers
2. Infirmaries 6. Drug manufacturers
3. Birthing homes 7. Institutions
4. Clinics and other health-related facilities 8. Mortuary and autopsy centers

ELEMENTS REQUIRED FOR INFECTION FROM MEDICAL WASTE

- Some components of the medical waste are potential reservoirs of disease-causing microorganisms.
- The infective dose depends on the virulence of the microorganisms, the portal of entry, and the
susceptibility of the host. (Chain of Infection)
- Modes of transmission may involve:
1. Contact (direct or indirect) (e.g., contaminated needles or blood splatter)
2. Vehicle-borne (e.g., Fomites – contaminated door knobs etc.)
3. Airborne (e.g., aerosolized pathogens from broken culture dishes or the rupture of yellow bags)
4. Vector-borne transmission (e.g., rodents in a medical waste storage area)
- Portals of entry – Include breaks in the skin and mucous membranes, the respiratory tract, etc.
1. Direct 2. Indirect 3. Fomite 4. Airborne 5. Vector borne
TYPES OF MEDICAL WASTE
1. Infectious Waste 4. Radioactive Waste
2. Sharps Waste 5. Non-Hazardous Waste
3. Pharmaceutical Waste

CATEGORIES OF HEALTH CARE WASTES

1. Infectious Waste – yellow plastic bag
- All wastes suspected to contain pathogens or toxins that may cause disease to a susceptible host.
Ex: microbial cultures, solid wastes with infections, blood bags, liquid wastes with infections, food
wastes coming from patients

2. Pathological and Anatomical Waste – leak- proof bin/yellow plastic bag

- Tissue sections and body fluids or organs derived from biopsies, autopsies or surgical procedures
- Anatomical waste – Recognizable body parts from amputation procedures
Ex: Histopathological examination samples
3. Sharps Waste – Red puncture- proof container
- Waste items that can cause cuts, pricks or puncture wounds
- Most dangerous because of their potential to cause both INJURY and INFECTION
Ex: Syringes, blood lancets, surgical knives, broken glasswares
4. Chemical Waste – Yellow bin
- Discarded chemicals (solid, liquid, gaseous) generated during disinfection and sterilization procedures
- Wastes with high content of heavy metals
Ex: Laboratory reagents, x-ray film developing solutions, and mercury from broken thermometers and
sphygmomanometers
- AMBER BOTTLES (LEAK PROOF) Yellow with black band liner

Classification of Hazardous Chemical Waste

• Toxic - health and environment hazards
• Corrosive – acid of pH<2 and base of >12
• Flammable – with flash point below 60°C
• Reactive – explosive with water
5. Pharmaceutical Waste – leak proof/yellow plastic bag
- Expired, spilt and contaminated pharmaceutical products, drugs, vaccines, antineoplastic drugs
Ex: Empty drug vials, medicine bottles, containers of cytotoxic drugs such as syringes, needles and vials
6. Radioactive Waste – leak- proof/yellow plastic bag/radiation proof containers
- Wastes exposed to radionucleotides including radioactive diagnostic materials or radiotherapeutic
materials
Ex: products used by patients exposed to radionucleotides within 48 hours

7. Non-Hazardous or General Waste – Green for biodegradable, black or colorless non-biodegradable

- Wastes that have not been in contact with communicable or infectious agents
Ex: Plastic bottles, used paper products, office wastes, food waste, empty intravenous bags not
containing medication (ex. saline or electrolytes)

INTERNATIONAL AGREEMENTS PERTAINING TO HEALTH CARE WASTE MANAGEMENT

1. The Montreal Protocol on Substances that deplete the Ozone layer (1987) – was adopted in Montreal,
Canada on September 16, 1987 and came into force, as agreed upon, on January 1, 1989. It sets the final
objective of the protocol to eliminate ozone depleting substances in the environment.

2. The Basel convention on the Control of the Transboundary Movements of Hazardous Wastes and their
Disposal (1989) – is concerned with the transboundary movements of hazardous waste. The countries that
signed the Convention accepted the principle that only legitimate transboundary shipments of hazardous
waste are exported from countries that lack the facilities or expertise to safely dispose certain wastes to other
countries that have both facilities and expertise.

3. The United Nations Framework Convention on Climate Change (1992) – includes a legally non-binding
pledge that by the year 2000, major industrialized nations would voluntarily reduce their greenhouse gas
emissions to 1990 levels.

4. The Stockholm Convention on Persistent Organic Pollutants (2001) – is a global treaty to protect human
health and the environment from persistent organic pollutants (POPs). POPs are chemicals that (1) remain
unchanged in the environment for long periods of time; (2) accumulate in the fatty tissues of living organisms;
and (3) are toxic to both humans and wildlife.
5. The ASEAN Framework Agreement on the Facilitation of Goods in Transit – is a core instrument that
provides nine high level protocols that set out generic standards to be put into place for the implementation
of an international transit system. Specifically, the framework agreement includes Protocol 9 on Dangerous
Goods which provides provisions on the transport of toxic and infectious substances.

NATIONAL LAWS AND POLICIES ON HEALTH CARE WASTE MANAGEMENT

1. RA 4226 – Hospital Licensure Act (1965) is an act that requires the registration and licensure of all hospitals
in the country and mandates the DOH to provide guidelines for hospital technical standards as to personnel,
equipment, and physical facilities.

A. DOH AO No.70-A series of 2002

B. DOH AO No.2005-0029 amended by DOH AO No. 70-A series of 2002
C. DOH AO No. 2007-0027 (August 22, 2007)
2. RA 6969 – An act to Control Substances and Hazardous and Nuclear Wastes (1990)
A. DENR AO No.36 series of 2004
B. DOH-DENR No.2 series of 2005
C. DOH AO No. 2007-0014
3. RA 8749 – The Philippine Clean Air Act of 1999
4. RA 9003 – Ecological Solid Waste Management Act of 2000
5. RA 9275 – The Philippine Clean Air Act of 2004
6. PD 813 and EO 927 (1975)
7. PD 856 – The Code Sanitation of the Philippines
8. PD 984
9. PD 1586
10. EO No. 301 “
11.DOH AO No.2008-0021
12. DOH AO No. 2008-0023
13. DOH Manual on Health Care Waste Management in 2011
14. Philhealth Benchbook for Quality Assurance in Health care (2006) – includes health care waste
management as one of its parameters in the quality assurance of healthcare.
15. BFAD Memorandum Circular No. 22 series of 1994: “Inventory, Proper Disposal, and/or Destruction of
used Vials or Bottles” and BFAD Bureau Circular No. 16, Series 1999: “Amending BFAD MV No. 22 dated
September 8, 1994, Regarding Inventory, Proper Disposal, and/or Destruction of used Vials or Bottles”

DENR ENVIRONMENTAL MANAGEMENT BUREAU (UNIVERSALLY ACCEPTED HAZARD

SYMBOL)

TREATMENT AND DISPOSAL

Pyrolysis – Thermal decomposition of health care waste in the absence of supplied molecular oxygen
Autoclave – Steam sterilization 1210C with a pressure of 15 psi for 15-30 minutes
Microwave – Temperature rise to 1000C (237.60F) for at least 30 minutes, use of moist heat
Chemical Disinfection – 5% sodium hypochlorite content
Biological Process – Uses an enzyme mixture to remove water for wastewater disposal
Encapsulation – Filling the containers with waste, immobilizing the material and sealing containers then
disposed in a landfill
Inertization – For pharmaceutical waste, mixing waste with cement before disposal. Inexpensive.